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Home / Equine Research Bank / J Bone Joint Surg Am / Minimally Manipulated Bone Marrow Concentrate Compared with ...
The Journal of bone and joint surgery. American volume2018; 100(2); 138-146; doi: 10.2106/JBJS.17.00132

Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model.

Abstract: Microfracture is commonly performed for cartilage repair but usually results in fibrocartilage. Microfracture augmented by autologous bone marrow concentrate (BMC) was previously shown to yield structurally superior cartilage repairs in an equine model compared with microfracture alone. The current study was performed to test the hypothesis that autologous BMC without concomitant microfracture improves cartilage repair compared with microfracture alone. Methods: Autologous sternal bone marrow aspirate (BMA) was concentrated using a commercial system. Cells from BMC were evaluated for chondrogenic potential in vitro and in vivo. Bilateral full-thickness chondral defects (15-mm diameter) were created on the midlateral trochlear ridge in 8 horses. Paired defects were randomly assigned to treatment with BMC without concomitant microfracture, or to microfracture alone. The repairs were evaluated at 1 year by in vitro assessment, arthroscopy, morphological magnetic resonance imaging (MRI), quantitative T2-weighted and ultrashort echo time enhanced T2* (UTE-T2*) MRI mapping, and histological assessment. Results: Culture-expanded but not freshly isolated cells from BMA and BMC underwent cartilage differentiation in vitro. In vivo, cartilage repairs in both groups were fibrous to fibrocartilaginous at 1 year of follow-up, with no differences observed between BMC and microfracture by arthroscopy, T2 and UTE-T2* MRI values, and histological assessment (p > 0.05). Morphological MRI showed subchondral bone changes not observed by arthroscopy and improved overall outcomes for the BMC repairs (p = 0.03). Differences in repair tissue UTE-T2* texture features were observed between the treatment groups (p < 0.05). Conclusions: When BMC was applied directly to critical-sized, full-thickness chondral defects in an equine model, the cartilage repair results were similar to those of microfracture. Our data suggest that, given the few mesenchymal stem cells in minimally manipulated BMC, other mechanisms such as paracrine, anti-inflammatory, or immunomodulatory effects may have been responsible for tissue regeneration in a previous study in which BMC was applied to microfractured repairs. While our conclusions are limited by small numbers, the better MRI outcomes for the BMC repairs may have been related to reduced surgical trauma to the subchondral bone. Conclusions: MRI provides important information on chondral defect subsurface repair organization and subchondral bone structure that is not well assessed by arthroscopy.
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Publication Date: 2018-01-18 PubMed ID: 29342064PubMed Central: PMC6819026DOI: 10.2106/JBJS.17.00132Google Scholar: Lookup
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  • Comparative Study
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research investigates the effectiveness of minimally manipulated bone marrow concentrate (BMC) in repairing full-thickness cartilage defects, comparing it to the common practice of microfracturing. The exploration shows that the usage of autologous BMC, without accompanying microfracture, yields results similar to microfracture treatment alone. However, additional findings suggest potential benefits of BMC, likely due to less surgical impact on subchondral bone.

Methodology

  • The study used eight horses with full-thickness chondral defects. The ailment was treated using either autologous BMC without concomitant microfracture or microfracturing alone.
  • The BMC, derived from sternal bone marrow aspirate (BMA) of the horses, was processed through a commercial system for the purpose of this study.
  • The cells extracted from BMC were assessed for their chondrogenic potential both in vitro and in vivo.
  • The effectiveness of both treatments was analyzed using various techniques such as in vitro assessment, arthroscopy, morphological magnetic resonance imaging (MRI), quantitative T2-weighted and ultrashort echo time enhanced T2* (UTE-T2*) MRI mapping, and histological assessment.

Results and Findings

  • The results showed that cells extracted from BMA and BMC showcased cartilage differentiation capability in vitro after culture expansion but not in the freshly isolated state.
  • One year after treatment, the repaired cartilage in both BMC and microfracture conditions were fibrous to fibrocartilaginous without any significant difference between the two methods as validated by arthroscopy, T2 and UTE-T2* MRI values, and histological assessment.
  • Morphological MRI revealed changes in subchondral bone not registered by arthroscopy and an overall improved outcome for BMC repairs. Differences in UTE-T2* texture features of the repair tissue were noticed between the treatment groups.

Implications and Conclusions

  • The data indicates that minimally manipulated BMC delivers similar cartilage repair results as microfracture. The paucity of mesenchymal stem cells in BMC suggests other mechanisms like paracrine, anti-inflammatory, or immunomodulatory effects could be instrumental in facilitating tissue regeneration, as observed in an earlier study where BMC was applied to a microfractured repair site.
  • Better MRI results for BMC repairs were possibly the result of reduced surgical trauma to subchondral bone. However, this inference is restricted by the study’s limited numbers.
  • The study concludes that MRI is a valuable tool in providing detailed information about subsurface repair organization and subchondral bone structure in chondral defects, data that arthroscopy fails to assess thoroughly.

Cite This Article

APA
Chu CR, Fortier LA, Williams A, Payne KA, McCarrel TM, Bowers ME, Jaramillo D. (2018). Minimally Manipulated Bone Marrow Concentrate Compared with Microfracture Treatment of Full-Thickness Chondral Defects: A One-Year Study in an Equine Model. J Bone Joint Surg Am, 100(2), 138-146. https://doi.org/10.2106/JBJS.17.00132

Publication

The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
NlmUniqueID: 0014030
Country: United States
Language: English
Volume: 100
Issue: 2
Pages: 138-146

Researcher Affiliations

Chu, Constance R
  • Department of Orthopedic Surgery, Stanford University, Stanford, California.
  • VA Palo Alto Health Care System, Palo Alto, California.
Fortier, Lisa A
  • College of Veterinary Medicine, Cornell University, Ithaca, New York.
Williams, Ashley
  • Department of Orthopedic Surgery, Stanford University, Stanford, California.
Payne, Karin A
  • Department of Orthopedics, University of Colorado, Aurora, Colorado.
McCarrel, Taralyn M
  • College of Veterinary Medicine, University of Florida, Gainesville, Florida.
Bowers, Megan E
  • George Washington University, Washington, DC.
Jaramillo, Diego
  • VA Palo Alto Health Care System, Palo Alto, California.
  • Nicklaus Children's Hospital, Miami, Florida.

MeSH Terms

  • Animals
  • Arthroscopy
  • Bone Marrow Transplantation
  • Cartilage, Articular / injuries
  • Cartilage, Articular / surgery
  • Disease Models, Animal
  • Horses
  • Magnetic Resonance Imaging
  • Random Allocation
  • Stifle / injuries
  • Stifle / surgery
  • Transplantation, Autologous
  • Wound Healing / physiology

Grant Funding

  • R01 AR051963 / NIAMS NIH HHS
  • R01 AR052784 / NIAMS NIH HHS
  • RC2 AR058929 / NIAMS NIH HHS

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